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We report on a 50-year-old female patient, with several severe comorbidities and high-surgical risk, in whom we successfully performed a simultaneous transcatheter pulmonary and tricuspid valve-in-ring implantation to treat both bioprosthetic pulmonary valve dysfunction and native torrential tricuspid valve regurgitation, the latter previously managed with a Carpentier annuloplasty ring.

Percutaneous pulmonary valve implantation is a less invasive procedure to treat right outflow tract dysfunction related to surgical procedures such as repair of Tetralogy of Fallot. Despite the lower risks, complications have been reported, namely embolisation of the pre-stent. We report a case of a 16-year-old boy, whose procedure was complicated by embolisation of the pre-stents and the strategy used to reimplant them, prior to the successful implantation of a pulmonary valve.

Background:The use of statins in children, although not frequent, is recommended in specific clinical contexts, namely, familial hypercholesterolaemia, conditions carrying a moderate-high cardiovascular risk and sub-optimal cholesterol levels after implementation of lifestyle modifications. The aim of this study is to characterise children with dyslipidaemia managed with statins, followed at a tertiary referral centre in central Portugal.Methods and results:The authors carried out a retrospective and descriptive study made up of 66 patients (50% males, mean age of therapy onset 11.9 years) followed up at the Cardiovascular Clinic of a tertiary referral centre between January, 2012, and May, 2018. Clinical, analytical, and echocardiographic parameters were analysed. About 60.6% had clinical and/or molecular diagnosis of familial hypercholesterolaemia. On average, each patient had three cardiovascular risk factors, obesity (31%) being most prevalent, followed by arterial hypertension (14%). Statin therapy showed a statistically significant reduction in the lipid profile, particularly in the total cholesterol (23%) and low-density lipoprotein cholesterol (30%) levels, as well as in the carotid intima-media thickness (p = 0.015). Hepatic and muscle integrity markers were within normal range.Conclusions:Statins are safe and efficient in the management of children with hypercholesterolaemia. Our study showed that apart from its lipid-lowering properties, it also reduced significantly the carotid intima-media thickness and, implicitly, the cardiovascular risk of these patients.

HIV-uninfected children exposed prenatally to the virus and to prophylactic antiretroviral therapy are at an uncertain risk of long-term myocardial dysfunction. This study aimed to analyse the structure and function of their ventricles and to identify potential screening tools for this at-risk population. One hundred and fifteen children (77 exposed vs 38 controls) aged between 2.7 and 16.2 years were included. An echocardiographic study was performed where both ventricles' dimensions and systolic functions were evaluated. In the left ventricle, parameters related to diastolic function were also analysed. Tissue Doppler values were determined in the basal state and after passive leg raising. Serologic analysis of amino-terminal pro-B-type natriuretic peptide (NT-proBNP) was carried out. The two groups had identical ventricular sizes and left ventricular diastolic functions. However, contractility assessed by myocardial peak systolic velocity was significantly inferior in the exposed group. These systolic echocardiographic differences were present despite similar values of NT-proBNP in both groups.Conclusion: HIV-exposed uninfected children may be vulnerable to ventricular systolic dysfunction at long term. Cardiovascular surveillance and periodic monitoring of biventricular function are therefore recommended. Myocardial peak systolic velocity may be a useful screening tool for this purpose.What is Known:• Previous studies on HIV-exposed uninfected children subjected prenatally to antiretroviral therapy have alerted to potential long-term cardiovascular toxicity effects on the left ventricle.What is New:• The study gives new insights on ventricular function and morphology in HIV-exposed uninfected children.• Myocardial peak systolic velocities are significantly inferior in this paediatric sub-group, therefore long-term cardiac surveillance is recommended.

Value analysis methodology uses a structured and methodical job plan contemplating several steps to ensure success in its application. This paper intends to perspective the potential of value analysis application, namely in the furniture industry. To draw conclusions of this potential a case study was developed at an IKEA factory in Portugal. To characterize the customer needs in a clear language and to quantify the value of a product (a bookcase) produced in this factory, a value analysis study was developed. Functional analysis is the most known and distinctive phase of value analysis and is, nowadays, an autonomous tool. With this functional analysis, the authors intend to describe the functions that the product performs, to provide a better knowledge of the product, to evaluate the degree of satisfaction of the product through its functional performance and to facilitate the search for alternative solutions. The results obtained allowed us to reach some important conclusions about the application of value analysis in this type of industry and can be an initial step I to promote the use of this tool in this kind of industry., This work has been supported by FCT –Fundação para a Ciência e Tecnologiawithin the Project Scope: UID/615/2019. Moreover, the authors thank the enriching improvement suggestions of the Journal reviewers.

Ruptured sinus of Valsalva aneurysm is a rare entity in children. To our knowledge, this is the youngest child reported in the literature with a sinus of Valsalva ruptured aneurysm being successfully treated percutaneously using an AmplatzerTM Duct Occluder II Additional Sizes device.

Background: Congenital heart disease is the leading cause of mortality among all congenital malformations. Objectives: To evaluate the incidence of congenital heart diseases in a central maternity hospital in Portugal from January 2003 to December 2018 and to determine survival in the first year of life. Methods: Retrospective analysis of newborns diagnosed with congenital heart diseases within 72 hours after birth. Malformations were divided according to pathophysiology. Cumulative survival analysis was performed by the Kaplan-Meier test. Stastical significance was set at p

Youth obesity is a strong predictor of adult obesity, which has well-known negative health consequences. Thus, addressing adult obesity requires tackling youth obesity. MED4Youth’s main objective is to strengthen the link between the Mediterranean Diet (MD) and the health benefits against youth obesity and associated cardiovascular disease (CVD) risk factors, identifying positive effects exerted by an MD including sourdough bread and healthy products from the Mediterranean basis (chickpeas/hummus, nuts, and pomegranate juice). For this purpose, a multicenter randomized controlled trial in which an MD-based intervention will be compared to a traditional low-fat diet intervention will be carried out with 240 overweight and obese adolescents (13–17 years) from Spain, Portugal, and Italy. Both interventions will be combined with an educational web-application addressed to engage the adolescents through a learning-through-playing approach, using both educational materials and games. To assess the interventions, adherence to the MD, dietary records, physical activity, food frequency, sociodemographic, and quality of life questionnaires as well as classical anthropometric and biochemical parameters will be evaluated. Furthermore, an omics approach will be performed to elucidate whether the interventions can shape the gut microbiota and gut-derived metabolites to gain knowledge on the mechanisms through which the MD can exert its beneficial effects.

Nowadays, companies are facing a constant need to develop and increase coordination between operational functions to respond rapidly and accurately to customer requests. Linked with this need, an increasing number of practitioners are resorting to an established and integrated business management methodology, the Sales and Operations Planning (S&OP). The concept of S&OP has gained increased recognition over the years by several authors and companies. This project describes the S&OP implementation in Sogrape Vinhos (wines) S.A., a Portuguese wine producer and distributer. The company was confronted with low accuracy in the establishing the forecast demand plans, especially on a long-term horizon. In order to increase the demand plans accuracy, the company started a S&OP implementation program. This paper describes the company’s current planning process, explains the S&OP’s implementation model presenting the selected parameters adequate to the company’s context, and finally, evaluate the expected outcomes of this project. Preliminary results from the S&OP implementation project at Sogrape indicate significant savings at the operational level and greater effectiveness in developing the company’s demand plans.

Esta dissertação teve como objetivo a realização de um estado da arte sobre a temática dos odores, abordando as suas metodologias de monitorização, estratégias de mitigação e correção, identificação de legislação e regulamentação nacional e europeia e elaboração de uma caracterização do panorama nacional de odores. Para este efeito foi feita uma revisão bibliográfica de artigos científicos e entrevistas com alguns atores portugueses. A monitorização de odores começa pela amostragem, cujas metodologias variam com o tipo de fonte, podendo estas ser pontuais, em volume ou de superfície. A medição da concentração de odores, geralmente é feita em unidades de odor por metro cúbico (oue/m3 ), pode ser realizada por métodos analíticos, métodos sensoriais ou por métodos eletrónicos. A modelação de odores é também uma importante metodologia de monitorização, que permite prever efeitos das condições topográficas e meteorológicas assim como o efeito de novas fontes e avaliar os impactos de diferentes estratégias de gestão. O controlo de odores é também um aspeto fulcral para a diminuição do seu impacto, começando desde logo na fase de construção das instalações e continuando com a aplicação das “Melhores Técnicas Disponíveis” de cada setor. Quando as medidas preventivas se revelarem insuficientes deverão ser aplicadas tecnologias curativas. Não existe ainda legislação específica de odores quer em Portugal quer na União Europeia, o que é colmatado com a existência de normas europeias que estabelecem metodologias de determinação da concentração de odor por Olfatometria e medição de campo (Métodos da Grelha e do Penacho). Nos últimos anos, a temática dos odores tem ganho relevância, quer ao nível social, quer ao nível industrial, tendo vindo a ser incorporados na legislação denominada “Documento de Referência das Melhores Técnicas Disponíveis” de algumas indústrias. Foram analisados 7 casos de estudo realizados em Portugal e entrevistados 3 atores portugueses, o que permitiu perceber que as indústrias mais preocupadas com a poluição odoríferas em Portugal são as do tratamento de águas residuais, os aterros, a transformação de produtos de origem animal, as centrais de compostagem e algumas indústrias mais especificas como a do bagaço de azeitona e da celulose. Alguns projetos foram criados com o intuito de sensibilizar a comunidade para a temática e aproximá-la ao processo de mapeamento de episódios de odor e facilitar o processo de queixa. Este é um problema que afeta não só a qualidade de vida e saúde das populações como tem impactos económicos, nomeadamente no preço de terrenos próximos das fontes. A falta de legislação específica com limites emissão é a maior lacuna encontrada.ao longo deste trabalho. Futuramente, deverá haver uma aproximação da comunidade com o problema de modo a agilizar os processos de queixa e monitorização, assim como deve ser criada legislação específica que tenha em consideração as especificidades técnicas e geográficas de cada setor. This dissertation aimed to achieve a state of art on the odour pollution issue, addressing its monitoring methodologies, mitigation and correction strategies, identification of national and European legislation and regulations and elaboration of a characterization of the national odour panorama. For this purpose, a bibliographic review of scientific papers and was carried out in a first phase and, in a second phase, interviews were conducted with Portuguese stakeholders. The monitoring of odors begins with sampling, whose methodologies change with the type of source, which can be a point source, in volume or surface. The odour concentration measurement is usually done in odour units per cubic meter (oue/m3 ), and it can be performed by analytical methods, sensory methods or by electronic methods. Odour modelling is also an important monitoring methodology, which allows forecasting the effects of topographic and meteorological conditions as well as the effect of new sources and assessing the impacts of different management strategies. Odour control is also a key aspect in reducing its impact, starting right from the construction phase of the facilities and continuing with the application of the “Best Available Techniques” of each sector. When preventive measures prove to be insufficient, curative technologies should be applied. There is still no specific odour legislation either in Portugal or in the European Union, which is complemented by the existence of European standards that establish methodologies for determining the odour concentration by olfactometry and field measurement (Grid and Plume methods). In recent years, odours have increased its relevance, having been incorporated into the legislation called “Reference Document of the Best Available Techniques” of some industries. Seven case studies carried out in Portugal were analysed and 3 stakeholders were interviewed, which allowed to realize that the industries most associated with odour pollution in Portugal are wastewater treatment, landfills, transformation of animal products, power plants. composting and some more specific industries such as olive pomace and cellulose. Some projects were created with the aim of sensitizing the community to this issue and bringing it closer to the process of mapping odour episodes and facilitating the complaint process. This is a problem that affects not only the quality of life and health of the population, but also has economic impacts, namely on the price of land close to the sources. The lack of specific legislation with emission limits is the biggest gap found throughout this work. In future works, there should be a community approach to the problem in order to streamline the complaints and monitoring processes, as well as legislation that takes into account the technical and geographical specificities of each sector. Mestrado em Engenharia do Ambiente

The selection of the resources system (SRS) is an important element in the integration/project of Agile/Virtual Enterprises (A/V E) because its performance is dependent of this selection, and even of its creation. However, it remains a difficult matter to solve because is still a very complex and uncertain problem. We propose that using Value Analysis (VA) in the pre-selection of resources phase represents a significant improvement of the SRS process. The current literature fails to formally address the pre-selection phase and none of the resource selection models incorporate the resources value and its consequence in the complexity of the selection process. Whereby, ours developed model with VA constitutes an innovative approach towards greater sustainability in the configuration of A/V E in the context of Industry 4.0, where a massive interconnection among enterprises is expected and consequently the increase of the selection process complexity. After the construction of a demonstrator tool for a set of the problem formulations, this paper verifies by computational results the thesis regarding the benefits of applying VA to the SRS process: VA reduces the complexity of the SRS process, even ensuring that the final system of resources achieve higher quality/value grade.

Pneumopericardium is a rare complication of pericardiocentesis (PC), occurring as a result of either a direct pleuropericardial communication or a leaky drainage system. Pneumopericardium is often self-limiting; however, physicians should be aware of this complication as it may progress to tension pneumopericardium, which requires immediate recognition and management. PC has been associated with pneumothorax, pneumomediastinum or subcutaneous emphysema, but the association with pleural effusion has been less reported. The authors present the case of a 14-year-old healthy boy who developed post-PC pneumopericardium and pleural effusion, a rare association reported in the literature. The diagnosis of this potential life-threatening event was made using readily available complementary diagnostic methods, such as transthoracic echocardiography and chest X-ray.

Superior–inferior ventricular arrangement with double-outlet left ventricle and malposition of the great arteries is an extremely rare congenital cardiac anomaly. The authors present the case of an infant who presented with cyanosis and respiratory distress. To the best of our knowledge, this is the first case reported.

Background: Human immunodeficiency virus infection is a recognized risk factor for premature atherosclerosis in children and adolescents. However, the atherosclerotic process in uninfected children exposed in utero to the virus and antiretroviral therapy is less clear. Objective: To determine the potential cardiovascular risk associated to this in utero milieu exposition. Material and Methods: A total of 115 individuals were studied (77 in the sample group and 38 in the controls). Eighteen analytical mediators involved in the atherogenic pathways (metabolic dysregulation, inflammation, and prothrombotic state) were analyzed. The carotid intima-media thickness, which is a subclinical marker of atherosclerosis, was also measured. Results: No significant statistical differences were identified between the sample and control groups, either in the biochemical or the echographic markers. Conclusion: In utero exposure to the HIV virus and antiretroviral therapy in uninfected children and adolescents is not correlated to accelerated atherosclerosis.

Background Transcatheter pulmonary valve replacement (TPVR) has emerged as an alternative to surgery in patients with pulmonary valve dysfunction. Methods We searched the Medline and Cochrane databases since their inception to January 2019 as well as references from article, for all publications comparing TPVR with surgical PVR (SPVR). Studies were considered for inclusion if they reported comparative data regarding any of the study endpoints. The primary endpoint was early mortality after PVR. Secondary endpoints included procedure-related complications, length of hospital stay, mortality during follow-up, infective endocarditis, need for reintervention, post-PVR transpulmonary peak systolic gradient, and significant pulmonary regurgitation. Results There were no differences in perioperative mortality between groups (0.2% vs 1.2%; pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27, I2 = 0%). However TPVR conferred a significant reduction in procedure-related complications and length of hospital stay compared with SPVR. Midterm mortality and the need for repeat intervention were similar with both techniques, but pooled infective endocarditis was significantly more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95% confidence interval, 1.89-5.06; P Conclusions TPVR is a safe alternative to SPVR in selected patients and is associated with a shorter length of hospital stay and fewer procedure-related complications. At midterm follow-up TPVR was comparable with SPVR in terms of mortality and repeat intervention but was associated with an increased risk of infective endocarditis.

Hypertrophic cardiomyopathy is the most common heritable cardiomyopathy, being the most frequent cause of sudden cardiac death in the young. Although sudden cardiac death risk stratification criteria have been validated for adults, its application is not recommended in a pediatric population. After considering risks and benefits, choosing the ideal candidate for an implantable cardioverter defibrillator (ICD) for primary prevention purposes still remains a challenge in a child with hypertrophic cardiomyopathy. In children, major issues concerning transvenous ICDs are those related to the lead implantation and the increased risk of systemic infections at mid-long term. With these in mind, it would appear that a subcutaneous ICD, in this population group, is an alternative to be considered. This case regarding a 30Kg, an 8-year-old child with hypertrophic cardiomyopathy highlights the difficulties in sudden cardiac death risk stratification, raises the questions related to which type of ICD to implant and illustrates the feasibility of a subcutaneous ICD in this particular setting.

The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure.The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension.BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25-30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension. Resumo: Em idade pediátrica a prevalência da hipertensão arterial (HTA) tem aumentado progressivamente, sendo a obesidade uma das responsáveis. Apesar disso, a etiologia dominante nesta faixa etária é a patologia renal e/ou a cardiovascular. A monitorização ambulatória de pressão arterial (MAPA) é o método de eleição para o diagnóstico de HTA, especialmente em crianças com risco cardiovascular elevado. O seu uso está limitado a crianças a partir dos cinco anos. A seleção do tamanho da braçadeira é o ponto chave na obtenção de leituras corretas da tensão arterial (TA).O MAPA tem como principal indicação a confirmação do diagnóstico de HTA. Também permite diagnosticar hipertensão da bata branca (que pode representar um estádio intermédio entre a fase normotensa e a hipertensão), ou hipertensão mascarada, associada a progressão para hipertensão mantida e HVE. As crianças com HTA noturna isolada devem ser consideradas como portadoras de hipertensão mascarada. A carga tensional é definida como a percentagem de medições válidas acima do p95 para a idade, sexo e estatura, sendo que valores superiores a 25-30% são patológicos e superiores a 50% são preditivos de hipertrofia ventricular esquerda (HVE). O MAPA correlaciona-se com lesão de órgão alvo, nomeadamente com a HVE e a lesão renal. É útil na diferenciação da hipertensão secundária, já que estas crianças manifestam maiores cargas tensionais e menor dipping nocturno, e na confirmação da resposta à terapêutica.Assim, o MAPA permite o diagnóstico e a classificação da HTA, fornece informação prognóstica cardiovascular e identifica doentes com fenótipos intermédios de HTA. Keywords: Pediatric age, High blood pressure, Ambulatory blood pressure monitoring, White coat hypertension, Masked hypertension, Target organ damage, Palavras-chave: Idade pediátrica, Hipertensão arterial, Monitorização ambulatória de pressão arterial, Hipertensão da bata branca, Hipertensão mascarada, Lesão de órgão alvo

Resumo: Em idade pediátrica a prevalência da hipertensão arterial (HTA) tem aumentado progressivamente, sendo a obesidade uma das responsáveis. Apesar disso, a etiologia dominante nesta faixa etária é a patologia renal e/ou a cardiovascular. A monitorização ambulatória de pressão arterial (MAPA) é o método de eleição para o diagnóstico de HTA, especialmente em crianças com risco cardiovascular elevado. O seu uso está limitado a crianças a partir dos cinco anos. A seleção do tamanho da braçadeira é o ponto chave na obtenção de leituras corretas da tensão arterial (TA).O MAPA tem como principal indicação a confirmação do diagnóstico de HTA. Também permite diagnosticar hipertensão da bata branca (que pode representar um estádio intermédio entre a fase normotensa e a hipertensão), ou hipertensão mascarada, associada a progressão para hipertensão mantida e HVE. As crianças com HTA noturna isolada devem ser consideradas como portadoras de hipertensão mascarada. A carga tensional é definida como a percentagem de medições válidas acima do p95 para a idade, sexo e estatura, sendo que valores superiores a 25‐30% são patológicos e superiores a 50% são preditivos de hipertrofia ventricular esquerda (HVE). O MAPA correlaciona‐se com lesão de órgão alvo, nomeadamente com a HVE e a lesão renal. É útil na diferenciação da hipertensão secundária, já que estas crianças manifestam maiores cargas tensionais e menor dipping nocturno, e na confirmação da resposta à terapêutica.Assim, o MAPA permite o diagnóstico e a classificação da HTA, fornece informação prognóstica cardiovascular e identifica doentes com fenótipos intermédios de HTA. Abstract: The prevalence of high blood pressure (BP) at pediatric age has increased progressively, one of the causes of which is obesity. However, the dominant etiology in this age group is renal and/or cardiovascular pathology. Ambulatory blood pressure monitoring (ABPM) is the method of choice for the diagnosis of hypertension, especially in children at high cardiovascular risk. Its use is limited to children from five years of age. Choosing appropriate cuff size is key to obtaining correct blood pressure.The main indication for ABPM is to confirm the diagnosis of hypertension. It also allows the diagnosis of white coat hypertension (which may represent an intermediate stage between the normotensive phase and hypertension), or masked hypertension, associated with progression to sustained hypertension and left ventricular hypertrophy (LVH). Children with isolated nocturnal hypertension should be considered as having masked hypertension.BP load is defined as the percentage of valid measurements above the 95th percentile for age, gender, and height. Values above 25‐30% are pathological and those above 50% are predictive of LVH. ABPM correlates with target organ damage, particularly LVH and renal damage. It is useful in the differentiation of secondary hypertension, since these children show higher BP load and less nocturnal dipping, and confirmation of response to therapy. Thus ABPM allows the diagnosis and classification of hypertension, provides cardiovascular prognostic information and identifies patients with intermediate phenotypes of hypertension. Palavras‐chave: Idade pediátrica, Hipertensão arterial, Monitorização ambulatória de pressão arterial, Hipertensão da bata branca, Hipertensão mascarada, Lesão de órgão alvo, Keywords: Pediatric age, High blood pressure, Ambulatory blood pressure monitoring, White coat hypertension, Masked hypertension, Target organ damage

Congenital stenosis of the pulmonary veins is a rare condition whose outcome is guarded despite the available treatment options. We report a case of a 6-month-old infant with significant stenosis of all four pulmonary veins.

UID/HIS/04209/2013 This work reports the first systematic chemical characterization of Portuguese 18th century glassware. 28 selected glass fragments, recovered from an archaeological excavation carried out in the site where King D. João V of Portugal established an important glass manufacture, Real Fábrica de Vidros de Coina (Coina Royal Glass Factory), were studied. This factory operated from 1719 until 1747, the year in which the factory was transferred to Marinha Grande. The fragments were analysed by micro-energy dispersive X-ray fluorescence (micro-EDXRF), using a portable spectrometer ArtTAX, and scanning electron microscopy (SEM-EDX). The analytical data showed that a large variety of glass types was manufactured in that factory, namely soda-lime glass, mixed-alkali glass, high lime-low alkali glass, potash glass and lead glass. In general, the composition of the glass varies according to the function of the objects. It was demonstrated that micro-EDXRF can be an important tool to characterize museum glass objects when only in situ non-invasive analytical methods are allowed. authorsversion published

Solidification thermal parameters, such as growth rate, cooling rate and dendrite arm spacing (λ), have been measured in a hypoeutectic Al-Mg alloy directionally solidified under upward and downward transient heat flow conditions. The experimental setup used in this work consists of a water-cooled mould with heat being extracted from the bottom or the top, promoting upward and downward directional solidification, respectively. It is shown that the dendritic arm spacing are not significantly affected by interdendritic convection for both solidification configurations and single growth laws are proposed for both cases. The Bouchard- Kirkaldy model is shown to overestimate the experimental primary dendritic arm spacing, despite fitting properly the secondary dendrite arm spacing.

The paper aims to provide a source of information regarding the measurement of physical quantities, specifically those related to mechanical metrology. Since there is a lack of literature reviews referencing patents as a way of gathering useful information, we performed a systematic search for patents that could solve practical problems in this field. The methodology used focused on one of the most comprehensive patent database, Orbit.com, covering about 70,000,000 documents. This text gives a quick look at the fundamentals of the measurement literature and then points out the state-of-the-art concerning patents in the area of study. Additionally, data analysis shows the trends in the last five decades of patents about the subject. In total, 5686 documents are found and we compiled 10 examples of relevant patents for the quantities Length, Temperature and Mass, making this article a source of information for both scientific and non-scientific metrology community.

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Background Telemedicine services are promoting more access to healthcare. Portugal was an early adopter of telemedicine to overcome both its geological barriers and the shortage of healthcare professionals. The Pediatric Cardiology Service (PCS) at Coimbra University Hospital Centre (CHUC) has been using telemedicine to increase access and coverage since 1998. Their Pediatric Telecardiology Service has been daily connecting CHUC with 13 other Portuguese national hospitals, and regularly connecting with Portuguese-speaking African countries, through a teleconsultation platform. Methods This study aims at exploring the Pediatric Telecardiology Service’s evolution, through a comprehensive assessment of the PCS’s development, evolution and impact in public health, to better understand the critical factors for implementation and sustainability of telemedicine, in the context of healthcare services digitalization. A case study was performed, with cost-benefit, critical factors and organizational culture assessment. Finally, the Kingdon’s framework helped to understand the implementation and scale-up process and the role of policy-making. Results With the total of 32,685 out-patient teleconsultations, growing steadily from 1998 to 2016, the Pediatric Telecardiology Service has reached national and international recognition, being a pioneer and an active promotor of telemedicine. This telemedicine service has saved significant resources, about 1.1 million euros for the health system (e.g. in administrative and logistic costs) and approximately 419 euros per patient (considering an average of 1777 patients per year). PCS presents a dominant “Clan” culture. The Momentum’s critical factors for telemedicine service implementation enabled us to understand how barriers were overcome (e.g. political forces). Willingness, perseverance and teamwork, allied with partnership with key stakeholders, were the foundation for professionals’ engagement and service networking development. Its positive results, new regulations and the increasing support from the hospital board, set up a window of opportunity to establish a sustainable telemedicine service. Conclusion The Pediatric Telecardiology Service enables real-time communication and the sharing of clinical information, overcoming many barriers (from geographical ones to shortage of healthcare professionals), improving access to specialized care both in Portugal and Africa. Motivation and teamwork, and perseverance, were key for the Pediatric Telecardiology Service to tackle the window of opportunity which created conditions for sustainability.

As the earliest atherosclerotic lesions begin during childhood, our aim was to correlate gender-related adiposity to classical cardiovascular risk factors in a group of children.An observational and transversal analysis was carried out in a cohort consisting of 161 children of both sexes, aged 6 to 17 years of age. Waist circumference was correlated to leptin, high-sensitivity C-reactive protein, systolic and diastolic blood pressure, plasma lipids, homeostasis model assessment-insulin resistance, and the left ventricular mass index. After adjusting for age, waist circumference in boys, compared to girls, correlated more strongly and directly to systolic (r = 0.538; p 0.001) and diastolic blood pressure (ρ = 0.401; p 0.01), ApoB/ApoA ratio (ρ = 0.515; p 0.01), high-density lipoprotein cholesterol (r = -0.441; p 0.001), low-density lipoprotein cholesterol (ρ = 0.280; p 0.01), triglycerides (ρ = 0.420; p 0.001), homeostasis model assessment-insulin resistance (ρ = 0.463; p 0.001), and the left ventricular mass index (ρ = 0.286; p 0.01). A similar pattern was observed regarding the correlations between leptin, high-sensitivity C-reactive protein, and the above parameters (except between high-sensitivity C-reactive protein and diastolic blood pressure), and also, particularly in boys.Although increased childhood adiposity is related to a more adverse metabolic and clinical profile in both genders, males appear to have a potentially greater cardiovascular risk.Obesity is characterized by a chronic low-grade inflammatory process.Increased adiposity is related to a more pronounced pro-inflammatory response in boys. Childhood male adiposity is a potentially greater cardiovascular risk factor. Arterial hypertension, insulin resistance, and dyslipidemia is more strongly correlated to waist circumference in boys.

Introduction: Obesity is considered a global epidemy with important public health issues as it is an independent risk factor in the development of cardiovascular disorders. Material and Methods: Approximately 10% of the world’s paediatric population has excess weight or obesity and 40% of these will be obese adults. Obesity is characterized by a chronic, low grade, pro-inflammatory process that ultimately results in endothelial dysfunction, the trigger lesion leading to adult cardiovascular disease. This leads to an imbalance in the synthesis of mediators that normally regulate vascular homeostasis, particularly nitric oxide bioavailability, favoring a pro-atherosclerotic status, the hallmark of cardiovascular disorders. Results : These changes begin early in childhood and anatomopathological studies in children with excess weight or obesity have shown endothelial changes that represent the precursors of the atherosclerotic lesion. Discussion: Endothelial dysfunction is the earliest manifestation of the atherosclerotic lesion. It is evident in obese children and, as such, it potentially contributes towards cardiovascular disease in the adult. Conclusion: Although the clinical impact of these changes rarely manifest themselves in infancy, the presence of related biomarkers as well as vascular morphological changes can, at this early stage, be found and assessed.

Introduction: Obesity-related comorbidities are present in young obese children, providing a platform for early adult cardiovascular disorders. Objectives: To compare and correlate markers of adiposity to metabolic disturbances, vascular and cardiac morphology in a European pediatric obese cohort. Methods: We carried out an observational and transversal analysis in a cohort consisting of 121 obese children of both sexes, between the ages of 6 and 17 years. The control group consisted of 40 children with normal body mass index within the same age range. Markers of adiposity, plasma lipids and lipoproteins, homeostasis model assessment-insulin resistance, common carotid artery intima-media thickness and left ventricular diameters were analyzed. Results: There were statistically significant differences between the control and obese groups for the variables analyzed, all higher in the obese group, except for age, high-density lipoprotein cholesterol and adiponectin, higher in the control group. In the obese group, body mass index was directly correlated to left ventricular mass (r=0.542; p=0.001), the homeostasis model assessment-insulin resistance (r=0.378; p=

Introduction: Pediatric obesity is increasingly prevalent in the Portuguese population. Adipocyte dysfunction results in the expression of pro-inflammatory mediators that are responsible for the low-grade inflammatory process that characterizes obesity. Objectives: The aim of this study was to investigate the relationship between markers of adiposity, inflammation and adipokines in a Portuguese obese pediatric population. Methods: One hundred and twenty children of both sexes, aged 6–17 years, were included in this study. The control group consisted of 41 healthy normal-weight children. The variables analyzed were age, gender, body mass index, waist circumference, fat mass percentage, high-sensitivity C-reactive protein (hs-CRP), leptin and adiponectin. Results: There were significant differences between controls and obese children for all parameters analyzed. In the obese group, after controlling for age and gender, hs-CRP (p=0.041), adiponectin (p=0.019) and leptin (p

Um sistema de ritos nos quais, através da alegoria e do símbolo se procura proporcionar ao iniciado a Iluminação e uma irmandade de filósofos-construtores – este é o ideal da maçonaria que influenciou diversos desenvolvimentos científicos, culturais, políticos e sociais até aos dias de hoje., Um sistema de ritos nos quais, através da alegoria e do símbolo se procura proporcionar ao iniciado a Iluminação e uma irmandade de filósofos-construtores – este é o ideal da maçonaria que influenciou diversos desenvolvimentos científicos, culturais, políticos e sociais até aos dias de hoje. Está fora do âmbito deste painel temático definir a Franco-maçonaria como um movimento esotérico ou como não-esotérico. A prioridade que a maçonaria especulativa (historicamente, desde as constituições de Anderson de 1723) deu desde sempre ao livre-pensamento, não se compagina com a fixação de rótulos muito deterministas. Porém não escapa a qualquer análise a presença explícita de elementos do pensamento esotérico ocidental – mais concretamente provenientes do hermetismo, do neoplatonismo, do cristianismo gnóstico, da teosofia cristã, da cabala, da alquimia, do movimento rosacruz. Isso é visível no discurso simbólico e nos símbolos, na composição das narrativas mitológicas e na organização conceptual filosófica. A referência directa a uma Gnose através dos tempos, está presente também, explicitamente na obra filosófica de reconhecidos maçons criadores dos ritos, nomeadamente, por exemplo, no do rito escocês e nas palavras do cavaleiro Ramsay, na sua obra Os Princípios Filosóficos da Religião Natural e Revelada: explicados numa ordem geométrica. O eixo temático deste painel inclui questões como: • 1. Compreender mais amplamente as raízes e o sentido esotérico da simbólica maçónica; • 2. Reconhecer as fontes espirituais deste movimento no séc. XVII, no Renascimento e na Antiguidade; • 3. Compreender em que medida por sua vez os valores e ideais trabalhados na Franco-maçonaria inspiraram e promoveram o nascimento de novos movimentos esotéricos; • 4. Como e em que medida as próprias obediências maçónicas – permeando-se do “espírito do seu tempo” foram influenciadas pela busca existencial, pelas concepções e pelas práticas de movimentos esotéricos entretanto surgidos.

Anomalous origin of the left coronary artery from the pulmonary artery is a rare congenital heart defect and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an asymptomatic eight-year-old black girl referred from Cape Verde in order to clarify left ventricular dilatation and dysfunction with turbulent systolic and diastolic flows observed at the interventricular septum. At the age of three months, she was diagnosed with heart failure, subsequently classified as dilated cardiomyopathy. She improved clinically following anticongestive therapy, which was ongoing at the time of admission to our center. The echocardiogram suggested anomalous origin of the left coronary artery from the pulmonary artery, and the diagnosis was confirmed by computed tomography angiography and cardiac catheterization. The patient underwent successful direct implantation of the left coronary artery into the aorta, creating a dual coronary perfusion system. This case illustrates an unusual presentation of a rare heart condition that survived without a diagnosis after the first year of life. It also highlights the importance of multimodality imaging in these cases. Resumo: A Origem Anómala da Artéria Coronária Esquerda da Artéria Pulmonar é uma cardiopatia congénita rara e uma causa de isquemia miocárdica em idade pediátrica. A maioria dos casos não diagnosticados morre no primeiro ano de vida, sendo necessária a formação de uma extensa rede de colaterais para permitir a sobrevivência. O diagnóstico não é linear exigindo elevada suspeição clínica. Os autores apresentam o caso de uma criança de oito anos de idade, de raça negra, assintomática, referenciada de Cabo Verde para esclarecimento de dilatação e disfunção do ventrículo esquerdo com fluxos turbulentos sistodiastólicos a nível do septo interventricular. Dos antecedentes destacava-se quadro de insuficiência cardíaca diagnosticada aos três meses de idade, com avaliação posterior compatível com miocardiopatia dilatada. Teve melhoria clínica após início de terapêutica anticongestiva que mantinha na altura da admissão no nosso Centro. Ecocardiograficamente suspeitou-se de Origem Anómala da Artéria Coronária Esquerda da Artéria Pulmonar, sendo este diagnóstico confirmado através de angiotomografia computorizada e cateterismo cardíaco. A doente foi submetida, com sucesso, a implantação direta da artéria coronária esquerda na aorta permitindo criar um sistema de perfusão coronário duplo. Este caso ilustra uma forma incomum de uma patologia rara que sobreviveu sem diagnóstico após o primeiro ano de vida. Reforça igualmente a importância da multimodalidade de imagem nestes casos. Keywords: Anomalous left coronary artery from the pulmonary artery, Bland-White-Garland Syndrome, Coronary anomalies, Inter-coronary collateral circulation, Congenital heart disease, Takeuchi procedure, Palavras-chave: ALCAPA, Síndrome de Bland-White-Garland, Anomalia das coronárias, Circulação colateral inter-coronária, Cardiopatia congénita, Procedimento de Takeuchi

In the present study, Pb–Bi as a model of alloys from peritectic systems was directionally solidified under transient heat flow conditions, which is the class of heat flow encompassing the majority of industrial solidification processes. Some experiments were also carried out in a vertical tube furnace under cooling rates closer to equilibrium during solidification in order to broaden the range of solidification parameters. Thermal parameters such as the tip growth rate (VL) and the cooling rate were experimentally determined and correlated with the primary (λ1) and secondary (λ2) dendrite arm spacings by experimental growth laws. It is shown that the proposed growth laws are able to encompass also the growth of dendritic branches during steady state growth from the melt.

Soda-lime glasses doped with Eu3+ were synthesized using a variety of compositions, namely changing the fraction of CaO or Eu2O3. Those glasses were characterized with several techniques, including ellipsometry, UV–vis–NIR absorption spectroscopy, steady-state photoluminescence spectroscopy and time-resolved luminescence. The compositions' effects on optical properties such as refraction indexes, Eu3+ oscillator strengths and luminescence lifetimes were accessed from the analysis of the experimental results. Judd–Ofelt theory was used to analyze all these aspects, which allow the detection of a mismatch of optical properties from absorption and emission spectroscopy. This mismatch was confirmed from the time-resolved data, showing the existence of two different spectroscopic Eu3+ species. From those results it is concluded that there is evidence for lanthanide aggregation, giving rise to self-quenching effects that may be described through resonance energy transfer mechanisms. The difference between luminescence lifetimes for isolated and aggregated Eu(III) is interpreted as due to different interactions with oxygen in the matrix, namely degree of covalency of the Eu–O bond and point group symmetry of the lanthanide.

Resumo: A Origem Anómala da Artéria Coronária Esquerda da Artéria Pulmonar é uma cardiopatia congénita rara e uma causa de isquemia miocárdica em idade pediátrica. A maioria dos casos não diagnosticados morre no primeiro ano de vida, sendo necessária a formação de uma extensa rede de colaterais para permitir a sobrevivência. O diagnóstico não é linear exigindo elevada suspeição clínica. Os autores apresentam o caso de uma criança de oito anos de idade, de raça negra, assintomática, referenciada de Cabo Verde para esclarecimento de dilatação e disfunção do ventrículo esquerdo com fluxos turbulentos sistodiastólicos a nível do septo interventricular. Dos antecedentes destacava‐se quadro de insuficiência cardíaca diagnosticada aos três meses de idade, com avaliação posterior compatível com miocardiopatia dilatada. Teve melhoria clínica após início de terapêutica anticongestiva que mantinha na altura da admissão no nosso Centro. Ecocardiograficamente suspeitou‐se de Origem Anómala da Artéria Coronária Esquerda da Artéria Pulmonar, sendo este diagnóstico confirmado através de angiotomografia computorizada e cateterismo cardíaco. A doente foi submetida, com sucesso, a implantação direta da artéria coronária esquerda na aorta permitindo criar um sistema de perfusão coronário duplo. Este caso ilustra uma forma incomum de uma patologia rara que sobreviveu sem diagnóstico após o primeiro ano de vida. Reforça igualmente a importância da multimodalidade de imagem nestes casos. Abstract: Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery is a rare congenital heart disease and a cause of myocardial ischemia during childhood. Most undiagnosed cases die in the first year of life as an extensive collateral network is essential for survival. The diagnosis requires a high index of clinical suspicion. The authors present the case of an 8‐year‐old black asymptomatic child referred from Cape Verde Island in order to clarify left ventricular dilatation and dysfunction with systo‐diastolic turbulent flows observed at the interventricular septum. At the age of 3 months, she was diagnosed with heart failure, in the context of showing dilated cardiomyopathy. She was managed and clinically improved with anticongestive therapy, which she was still taking at the time of admission to our Center. The echocardiogram findings suggested Anomalous Origin of the Left Coronary Artery from the Pulmonary Artery and the diagnosis was confirmed by computerized angiotomography and cardiac catheterization. The patient was successfully submitted to direct implantation of the left coronary artery into the aorta, allowing the creation of a double coronary perfusion system. This case illustrates an unusual presentation of a rare pathology that survived without a diagnosis after the first year of life. It also reinforces the importance of multimodality image screening in these cases. Palavras‐chave: ALCAPA, Síndrome de Bland‐White‐Garland, Anomalia das coronárias, Circulação colateral inter‐coronária, Cardiopatia congénita, Procedimento de Takeuchi, Keywords: ALCAPA, Bland‐White‐Garland Syndrome, Coronary anomalies, Inter‐coronarian collateral circulation, Congenital cardiopathy, Takeuchi procedure

A diagnosis of congenital heart disease is usually established at an early age, so infective endocarditis is a rare form of presentation.The authors describe the case of a male adolescent with a week-long history of intermittent fever and unquantified weight loss. Physical examination detected pansystolic and diastolic murmurs, and an associated precordial thrill. Laboratory tests showed evidence of an active infection. Etiological investigation revealed a perimembranous ventricular septal defect, aortic regurgitation, and aortic and mitral valve vegetations. A diagnosis of mitral-aortic infective endocarditis was made and he was started on intravenous antibiotics and anticongestive therapy. After initial clinical improvement, he developed symptoms and signs of congestive heart failure. Repeat echocardiography showed an extensive mitral-aortic paravalvular abscess. The antibiotics were changed and anticongestive therapy was intensified, and he subsequently underwent surgery. The outcome has been generally favorable, and at present he is asymptomatic under anticongestive therapy. Resumo: O diagnóstico de cardiopatia congénita é estabelecido habitualmente em idade precoce, logo, a endocardite infecciosa é uma forma de apresentação rara desta patologia.Descreve-se um caso clínico de um adolescente com febre intermitente com uma semana de evolução e perda ponderal não quantificada. A observação detetou um sopro holossistólico rude e um sopro diastólico, associados a um frémito na região precordial. Analiticamente, apresentava sinais sugestivos de um processo infeccioso ativo. A investigação etiológica revelou a presença de uma comunicação interventricular perimembranosa restritiva, bicuspidia aórtica com regurgitação aórtica e vegetações a nível da válvula mitral e aórtica. Perante o diagnóstico de endocardite mitroaórtica, iniciou antibioterapia endovenosa associada a terapêutica anticongestiva. Após melhoria clínica inicial, desenvolveu quadro de insuficiência cardíaca congestiva. Repetiu o ecocardiograma, que mostrou abcesso paravalvular aórtico e mitral extenso. A antibioterapia foi substituída e a terapêutica anticongestiva foi intensificada. Foi posteriormente submetido a cirurgia cardíaca. A evolução tem sido favorável, mantendo-se assintomático sob terapêutica anticongestiva. Keywords: Infective endocarditis, Ventricular septal defect, Staphylococcus aureus, Palavras-chave: Endocardite infecciosa, Comunicação interventricular, Staphylococcus aureus

Due to its non-crystalline, amorphous structure, glass is particularly susceptible to radiation-induced coloration/discoloration. Oxide glasses reveal a variety of colors depending upon their composition when exposed to high energy radiations such as gamma and X-rays, and the colors induced have been explained in terms of the formation of color centers. These effects can be reversed by heating or upon exposure to light at wavelengths corresponding to the absorption region of the color centers, a process known as discoloration. Laser can be an efficient process for accomplish this in a localized manner. The aim of this work was to study local discoloration of gamma radiation exposed silicate glasses by application of a nanosecond pulses infrared laser beam. Experimental results validated a numerical model and proved the viability of local laser discoloration of gamma ray irradiated silicate glasses. Although there has been much work focusing the creation and destruction of color centers in glasses, to the best of our knowledge, the application of infrared laser radiation in the local annealing of gamma irradiated glasses was for the first time explored.